Successful Closure of a Bronchopleural Fistula by Intrapleural Administration of Fibrin Sealant: A Case Report

Shrestha, Pranabh; Dieguez, Javier; Alberaqdar, Enis; Jawad, Sami Abdul; Rai, Srijana; Adelman, Marc

doi:10.1378/chest.1685553

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“…There is still a lack of consensus about the optimal management of the BPF, but individualized approach is usually recommended (6). Several strategies have been employed to manage the problem with variable success: surgery, direct closure with re-enforcement of pleural, pericardial, intercostal or omental flaps may be necessary; as a less invasive option, fibrin glue has been used by several investigators (7). Preoperative risk factors for the development of BPF are: fever, steroid use, elevated erythrocyte sedimentation rate and anemia; postoperative risk factors are: fever, steroid use, leukocytosis, tracheostomy and prolonged mechanical ventilation, repeated bronchoscopy for sputum suction and mucus plugging (8).…”

Section: Introductionmentioning

confidence: 99%

Treatments of post-surgical fistulas with particular emphasys to stem cells therapy

Petrella¹

2015

sob

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SummaryPost resectional bronchopleural fistula is a pathological connection between the airway and the pleural space that may develop after surgical lung resection. It is still the most feared complication about after curative lung resection because current treatments are often far to be satisfactory. For this reason great attention has been reached about the healing effects promoted by stem cells through transformation into mature cells with a specialized function or by enhancing intrinsic repair mechanisms. This may represent an effective therapeutic option, as showed by our team, only partially explored to date. Nevertheless, there is still a lack of consensus regarding the optimal management of a fistula, but an individualized approach is recommended. Several strategies have been suggested to manage this problematic condition with a variable success rate: invasive surgery, direct closure with re-enforcement of the pleura, or using flaps from pericardium, intercostal tissue or omentus. A less invasive option suggested by several Authors is the endoscopic use of fibrin glue or silver nitrate. In conclusion, although cellular therapies are a new interesting therapeutic approach for the closure of airway fistulas, more basic research and clinical experiences are needed to get this promising therapy as a routine tool for treating this insidious post-surgical complication. Currently, a standard surgical and conservative approach still remain the first choice therapeutic option for postsurgical broncho-pleural fistulas. KEY WORDS: bronchopleural fistula, mesenchimal stem cell, Eloesser flap, Clagget procedure. IntroductionPost resectional bronchopleural fistula (BPF) is a pathological connection between the airways and the pleural space that may develop after lung resection (1). It may be caused by incomplete bronchial closure, impediment of bronchial stump wound healing, or stump destruction by residual neoplastic tissue. The incidence of BPF after thoracic surgery for lung cancer ranges from 1 to 4%, whilst its mortality ranges from 12.5 to 71.2% (2). BPF is still the most feared complication after curative lung resection (3); for this reason the healing effects promoted by stem cells -by transformation into mature cells with a specialized function or by enhancing intrinsic repair mechanismsmay represent an effective and only partially explored therapeutic option (4, 5). There is still a lack of consensus about the optimal management of the BPF, but individualized approach is usually recommended (6). Several strategies have been employed to manage the problem with variable success: surgery, direct closure with re-enforcement of pleural, pericardial, intercostal or omental flaps may be necessary; as a less invasive option, fibrin glue has been used by several investigators (7). Preoperative risk factors for the development of BPF are: fever, steroid use, elevated erythrocyte sedimentation rate and anemia; postoperative risk factors are: fever, steroid use, leukocytosis, tracheostomy and prolonged mechanical ventil...

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Section: Introductionmentioning

confidence: 99%

Treatments of post-surgical fistulas with particular emphasys to stem cells therapy

Petrella¹

2015

sob

View full text Add to dashboard Cite

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Successful Closure of a Bronchopleural Fistula by Intrapleural Administration of Fibrin Sealant: A Case Report

Cited by 1 publication

References 0 publications

Treatments of post-surgical fistulas with particular emphasys to stem cells therapy

Treatments of post-surgical fistulas with particular emphasys to stem cells therapy

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